Provider Demographics
NPI:1700810322
Name:MOATES, LORI-ANN KATHERINE (RPH)
Entity Type:Individual
Prefix:
First Name:LORI-ANN
Middle Name:KATHERINE
Last Name:MOATES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11595 ANHINGA DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-5803
Mailing Address - Country:US
Mailing Address - Phone:561-793-5378
Mailing Address - Fax:
Practice Address - Street 1:4601 N CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3228
Practice Address - Country:US
Practice Address - Phone:561-881-1539
Practice Address - Fax:561-840-0797
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS1539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist